Practice Management Software Payment Processing Fees: What IBCLCs Actually Pay

After a home visit, you run the card on file. The portal shows the $200 visit as paid. Two days later, $193.40 reaches your bank account.

The $6.60 is the payment processing fee. Some cost is expected. Visa and Mastercard, the FSA and HSA cards parents use, fraud checks, and stored-card convenience all cost money. Card processing is a normal, unavoidable cost of running a private practice.

The useful question is how that $6.60 breaks down. On most platforms, about $6.10 is the payment processor's standard rate. The remaining $0.50 or so is an extra percentage that practice-management software can add to the sale. That markup is small on one visit, but it accumulates across a year of visits, packages, and balances. It is also one of the few software costs you can change without changing how you practice.

Look at the percentage charged on every transaction

The comparison uses two figures.

SimplePractice's support documentation lists an online payment "integration fee" of 3.15% + $0.30 per successful transaction. It applies to all major credit and debit cards, including FSA and HSA cards, whether you charge the card at the time of service or store it for later. SimplePractice publishes this rate in its own support docs, so it's disclosed, not buried. (More on that below.)

Stripe, the processor underneath a great many of these platforms, lists a standard U.S. domestic card rate of 2.9% + $0.30 per successful transaction.

The fixed $0.30 is identical. The difference is 0.25 percentage points added to the sale amount. That difference is the platform markup, which goes to the software company rather than the card networks.

A quarter of a percent is small on one visit. It applies to every dollar a patient pays through the platform, so check the total before deciding it does not matter.

What 0.25% costs over a year of patient payments

One transaction is easy to dismiss. The annual cost depends on how many payments you run.

A steady solo cash-pay practice runs somewhere around 8 to 15 visits a week, the range we landed on in TLN vs. direct-bill vs. cash-pay, which works out to roughly 35 to 65 card payments a month. At $200 a payment, the 0.25% markup comes to about $18 to $33 a month, or $210 to $390 a year. A newer or part-time practice seeing a few patients a week is more like $50 to $100 a year. A thriving full-time practice, a package-heavy one selling $400 to $600 bundles, or a two-provider office can clear $500 and up, since the markup is a percentage and the volume rises with it.

A few hundred dollars a year is not a reason to abandon a platform you otherwise like. It is a smaller line item than the template packs and setup time that already make a generic EHR cost more than its sticker price (we did that math separately). It is still money leaving your practice every month for nothing your patients can see or feel. Unlike rent or a credential renewal, this cost can change when you choose a different setup.

How other practice platforms compare

SimplePractice is a useful example because it is widely used and publishes its rate, but it does not represent the whole market. Most practice-management platforms run payments through Stripe or a similar processor, and their card rates fall within a fairly narrow band. The table shows standard online card rates listed by several platforms IBCLCs shop, as published in mid-2026:

("Not listed" means the platform does not prominently publish that rate, not that the method is unavailable. Confirm directly.)

Most platforms sit around Stripe's 2.9% baseline. Jane lists a rate slightly below it, so a practice platform does not have to add a markup. SimplePractice's 3.15% is at the higher end of the range. The headline percentage is not the whole cost. PracticeQ, for example, adds a $7.50 monthly PCI fee to its per-transaction rate, while ACH rates and caps differ by platform.

This does not make any of them a bad product. They are established tools, and the right fit depends on more than payment rates. When you compare them, include the payment costs rather than just the monthly subscription price, and confirm each number against the platform's current documentation because rates change.

The fee is published, even if people search for "hidden fees"

If you have been comparing software, you may have searched for "SimplePractice hidden fees" or "SimplePractice Stripe fees." The phrasing makes sense because a pricing page usually leads with the monthly subscription rather than the processing rate.

SimplePractice discloses its 3.15% + $0.30 rate in its support documentation. The fee is published and permitted. It is a normal platform markup, and SimplePractice is a well-supported product that many allied-health practices use. Calling a disclosed fee "hidden" is inaccurate.

The third-party information is less reliable. SimplePractice's current rate is 3.15% + $0.30, but many comparison articles and review sites still cite the older 2.7% + $0.30 figure. When sources disagree by half a percent, verify the rate yourself.

Do not use a number from any article, including this one, as your operative figure. Confirm your current rate in writing through your platform's billing settings or support documentation before you sign or switch. Rates change, and sources disagree.

ACH can reduce the cost of larger payments

Most "payment fees" articles leave out ACH. Not every payment has to use a card.

Card networks cost more because of the infrastructure, rewards, and fraud risk behind them. Bank transfers, called ACH in the U.S., use a different payment system and cost less. Stripe's ACH Direct Debit runs 0.8%, capped at $5.00 per transaction, compared with 2.9% + $0.30 for cards with no cap. The savings are modest on a small visit fee. They are larger on multi-visit packages, prenatal bundles, and payment plans. Because of the cap, a large payment costs no more than five dollars to collect.

ACH is slower. It settles in about three to five business days, and not every platform exposes it, so it does not help with collection at the end of a home visit. For invoiced packages, payment plans, and large balances where the parent is not standing in front of you, offering "pay by bank" alongside "pay by card" can reduce processing costs. A platform that supports only cards or does not let you choose which methods to accept has a real limitation.

Integrated payments have a real value

A higher integrated rate can buy a workflow that mostly takes care of itself. With a cheaper external processor, you may need to charge the card in one tool, wait for confirmation, return to your practice software, mark the invoice paid by hand, reconcile the processor's report with your books at month-end, and investigate failed or duplicated payments. That work also has a cost. It takes evenings and can create an accounting error that takes an hour to untangle.

Many seasoned IBCLCs decide that the extra 0.25% is a fair trade for clean books, one screen, and no reconciliation. That is a valid choice, and it is correct for many practices. Integrated payments save time, which is scarce in a solo practice.

Compare more than whether the software takes card payments. Ask "what does my whole payment workflow cost me, counting the software fee, the processing fee, the platform markup, and my reconciliation time, and is that markup buying me something I actually use?" Provider-aligned software should make the fee structure clear enough to answer without emailing support.

Five questions before you commit to a payment setup

When you compare practice-management tools, ask these five questions:

1. What's the exact card rate, percentage and fixed fee? Get the current number from the platform itself, not a review site.
2. Is that the processor's published rate, or a platform-specific one? If it's higher than the underlying processor's standard rate, the gap is the platform markup. Ask what it buys you.
3. Who owns the payment account? Is it your connected Stripe (or other processor) account, with money landing directly in your bank? Or a platform-controlled account that the money passes through?
4. Can you choose which payment methods to accept, and does it support ACH? Bank payments are where package-heavy practices save the most, and Apple Pay or Google Pay can speed up collection at the visit.
5. Does the platform take any extra cut of patient payments? Keep this separate from the monthly subscription, per-claim fees, SMS charges, and other add-ons, so you're comparing like for like.

The right answer is not always "lowest fee." A bargain processor that forces duplicate data entry can cost more in time and errors than it saves in cents. You cannot make that trade well without knowing which part of the fee comes from the processor and which part comes from the platform.

Two caveats for you and your patients

On surcharging. You may consider passing the card fee to the patient by adding a small percentage at checkout. Surcharging is outright illegal in a few states (Connecticut, Massachusetts, Maine, and Puerto Rico) and tightly restricted by card-network rules elsewhere. The restrictions include a cap of around 3%, mandatory disclosure on signage and receipts, and a flat ban on surcharging debit cards anywhere in the country. Before adding a card surcharge, check your state's law and your processor's rules, and disclose it clearly. For most small lactation practices, building the cost into the visit fee or steering large balances to ACH is cleaner than surcharging.

On taxes. Card processing fees are generally a deductible business expense for a sole proprietor or LLC practice, which reduces the real cost somewhat. This is general information, not tax advice. Confirm the specifics with your accountant.

Why payment fees matter for lactation practices

IBCLC private practice runs on thin margins, and a payment markup adds to costs you are already absorbing.

Cash-pay parents often pay out of pocket while they wait for superbill reimbursement that may never fully come through. Insurance-routed visits frequently pay less than the clinical time requires. Home visits include an hour of unbilled drive time, preparation, charting, and pediatrician follow-up in every "60-minute" appointment. (We broke that per-hour reality down in TLN vs. direct-bill vs. cash-pay.) No-shows happen, and supplies and travel come out of your pocket.

In that context, a recurring percentage taken from every payment reduces the money that reaches your bank account after you do the work. For a $200 visit, $0.50 is small. Across a year of visits, packages, and balances, it adds up, and it is one of the few costs you can change.

How NuBloom handles payments

NuBloom uses your own connected Stripe account. You connect Stripe from practice settings in a few minutes. Patients pay through the portal or a payment link you send, and the money goes straight to your bank account. Nothing passes through us.

Because the Stripe account is yours, you control payment intake. You decide which methods to accept and turn them on from your Stripe dashboard: cards, Apple Pay and Google Pay for collection at the visit, and ACH bank payments for large packages and payment plans where the capped 0.8% rate saves the most. You are not locked into a platform-set rate or a fixed menu of payment methods.

NuBloom does not add a percentage to Stripe's processing. Stripe still charges its standard rate (2.9% + $0.30 on standard U.S. cards), as it does on any platform. There is no markup on top of that rate and no slice of the payment routed back to us. Under our terms, NuBloom is not a party to the financial transaction between you and your patient. We charge for the software: $59 a month with messaging, reminders, templates, and analytics included, plus $39 a month for each additional billable seat (billing and read-only team members are free). Your payment processing remains separate.

This keeps the software price and payment math separate. For a feature-by-feature look at how this compares to a tiered platform, see NuBloom vs. SimplePractice or the full pricing breakdown.

Calculate the full cost before switching

Do not move platforms over fifty cents per transaction alone. Switching also has real costs, including rebuilding the templates and workflows you have already set up, as any IBCLC starting in private practice learns quickly.

Include the following in the calculation.

• monthly subscription and per-provider seats
• card processing rate (the part that's processor vs. platform markup)
• ACH availability, rate, and cap for your larger payments
• per-claim fees, SMS and reminder costs, template setup
• reconciliation time and billing workflow
• offline charting, if you do home visits

Choose the platform that fits the way your practice earns money. For some clinicians, a higher integrated rate is worth the cost for clean books. For others, especially cash-pay and package-heavy practices, a small extra percentage on every payment is the wrong recurring cost. Know which situation applies to you before every patient payment starts running through the platform.

To see a no-markup setup in practice, try NuBloom free for 14 days, with no credit card to start.

Frequently asked questions

How much does SimplePractice charge for payment processing?

SimplePractice lists an online payment integration fee of 3.15% plus $0.30 per successful transaction. It applies to all major credit, debit, FSA, and HSA cards. SimplePractice discloses the rate in its support documentation. Stripe's standard U.S. domestic card rate is 2.9% plus $0.30, so the difference is about 0.25 percentage points on each sale. That difference is the platform's markup.

Why are practice management software payment fees higher than Stripe's rate?

Most practice platforms process payments through Stripe or a similar processor, then add a small percentage on top, often called an integration fee. That amount goes to the software company, not the card networks. Many platforms use Stripe's 2.9% baseline, while some, such as SimplePractice at 3.15%, charge a quarter point or more above it. Confirm your rate in the platform's billing settings.

Can I use my own Stripe account with practice management software?

With some platforms, yes. NuBloom, for example, connects to your own Stripe account, so payments land directly in your bank and you control which methods you accept, including cards, Apple Pay, Google Pay, and ACH bank payments. Without a platform markup, you pay Stripe's standard rates directly. Other platforms use a managed payment account and set their own integration fee, so ask who owns the account before you commit.

Is ACH cheaper than credit cards for collecting patient payments?

Usually, for larger payments. Stripe's ACH Direct Debit runs about 0.8% capped at $5.00 per transaction, versus 2.9% plus $0.30 with no cap on cards. A $600 package costs roughly $4.80 by bank transfer instead of $17.70 by card. ACH settles in about three to five business days, so it fits invoiced packages and payment plans better than collection at the end of a visit.

Can lactation consultants pass credit card fees on to patients?

Surcharging is regulated. It is outright illegal in a few states, including Connecticut, Massachusetts, Maine, and Puerto Rico. Card-network rules restrict it elsewhere with a cap of around 3%, disclosure requirements, and a flat ban on surcharging debit cards anywhere. Before adding a card surcharge, check your state law and your processor's rules and disclose it clearly. For most small practices, building the cost into the visit fee or steering large balances to ACH is simpler.

Sources

• SimplePractice: Processing online payments (3.15% + $0.30 online payment integration fee)
• Stripe pricing (2.9% + $0.30 standard U.S. cards; 0.8% ACH Direct Debit, capped at $5)
• Jane: Understanding your payment processing fees (2.85% + $0.25 online, 2.6% + $0.10 in person)
• PracticeQ / IntakeQ Payments fee breakdown (2.9% + $0.30; 1% ACH, $10 cap; $7.50/month PCI fee)
• Healthie: card payments FAQ (2.9% + $0.30)

Verify every rate against your platform's current documentation before acting on it.